Category: Professional Posters
Purpose: The Patient Centered Medical Home model has risen in popularity to utilize multidisciplinary teams and continuous healthcare in the primary care setting. Many questions still exist on the effectiveness of the PCMH model on outcomes and costs. One component of interest is pharmacist inclusion in the PCMH model. Pharmacists under the PCMH model provide services such as medication therapy management and chronic disease state monitoring. The objective of this study was to compare associated healthcare costs for patients seen by a pharmacist under the PCMH model with those not seen by a pharmacist.
Methods: This retrospective case-control study was approved by the University of Nebraska Medical Center Institutional Review Board. This study was conducted at a large academic medical system in Omaha, Nebraska. A chart review was done to find PCMH patients participating in a pharmacist chronic disease state management service during calendar year 2018. Chronic disease states included diabetes, hypertension, and anticoagulation monitoring. Patients and the service they participated in were extracted from electronic health records. Using medical and pharmacy claims obtained through the partner accountable care organization, participating patients were matched to up to two controls with similar diagnoses, insurance provider, age, and risk-scores. The outcomes of interest were all cause hospitalizations and total costs obtained through claims data. Costs were also broken out by inpatient, ambulatory, prescription, and professional costs. All disease states were compared together and individually. Rates of hospitalizations were compared statistically using Chi-Square analysis while costs of services in different locations was compared using the Wilcoxon Ranked Sum test.
Results: A total of 244 pharmacist managed patients were matched to 415 control patients. That included 195 patients receiving anticoagulation services, 18 for hypertension, and 31 for diabetes. Hospitalization rates were low for both groups (4.1% for PCMH and 6.5% for controls) and the difference was not statistically significant for the disease states combined or individually. The mean net amount paid was higher in the PCMH participating group though not statistically significant ($12,756 versus $11,730, p=0.1527). The ambulatory and prescription costs were both significantly different, p= < 0.0001 for both. Ambulatory costs were higher for the PCMH group ($6,177 versus $4,794) while prescription costs were lower than the control group ($727 versus $1,187). Professional and hospital costs were not statistically different (p=0.1611 and p=0.3496) between the groups.
Conclusion: This analysis serves as a measure of financial impact of pharmacists under the PCMH program on costs associated with hospitalizations. Due to a small sample size from to limited complete claims data for all PCMH participating patients, only ambulatory and prescriptions costs were found to be significant. Having pharmacist management on the PCMH model showed a decrease in prescription costs and an increase in ambulatory care costs in this setting. Future research with a larger population and longer duration of follow-up are needed to adequately assess the financial impact of pharmacist involvement in the care of PCMH patients.